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National Center for Ethics in Health Care


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Preventive Ethics



Addressing Ethics Quality Gaps on a Systems Level

The Preventive Ethics component of IntegratedEthics®(IE) tackles recurring ethical concerns by applying quality improvement methods to identify and address ethics gaps on a systems level.

The IE model address chronic and recurrent ethical issues systemically, using a step-by-step quality improvement approach called ISSUES that includes the following:

Social worker and patient

Identify an Issue 
Study the Issue
Select a Strategy
Undertake a Plan
Evaluate and Adjust
Sustain and Spread  

Preventive Ethics National Initiatives

Tools for Improving Adherence to Inpatient Advance Directive Screening and Providing Assistance when Requested


Preventive Ethics: Addressing Ethics Quality Gaps on a Systems Level (Second Edition) - The primer provides an introduction to preventive ethics and outlines a step-by-step approach to improving systems and processes that influence ethics practices in a health care organization

Preventive Ethics: Addressing Ethics Quality Gaps on a Systems Level. Joint Commission Journal on Quality and Patient Safety. 

IntegratedEthics Policy - VHA Handbook 1004.06 


Preventive Ethics: Addressing Ethics Quality Gaps on a Systems Level - a 45-minute interactive training video on how to apply principles of quality improvement to proactively address ethics issues on a systems level.

VA 4180882 - Preventative Ethics (ISSUES) Adventure 1: Advance Directives - This training module allows the user to complete a PE cycle for improving the advance directives process at a VA medical center. It also allows the user to choose a pathway (make decisions) on the progression of the PE cycle and learn whether those decisions are successful or if another decision would be more optimal.  


Preventive Ethics core tools:

Document a completed improvement cycle:

Tools for Informed Consent for Long-Term Opioid Therapy for Pain:

 Six advanced training modules on key PE concepts for Preventive Ethics Coordinators and team members:

Tools to explain the role and responsibilities of the Preventive Ethics Coordinator:


IE Archive: Materials used in the initial launch of the VA IE program



What's New

New! True North, the newsletter of VA National Center for Ethics in Health Care. Issue 4 is available now!

New podcast!
Servant Leadership: Intersections with Ethics, Business Integrity & Compliance (43:49) A presentation by Dr. Maureen Cash, VHA National Center for Organization Development

New! The IE Council Member Orientation Guide located on the IE Program Management web page is designed to assist IE council members with the transition into their new role.

The second edition of Ethics Consultation: Responding to Ethics Questions in Health Care is now available. This primer establishes VA standards for health care ethics consultation, one of the three core functions of IntegratedEthics.